domingo, 29 de noviembre de 2009

Principio éticos de la investigación biomédica

The primer to ethical analysis provides an introduction to ethical decision-making. Theethical theories discussed serve only as a starting point for understanding thefoundations of moral philosophy. These foundations are being continually debatedand revised.FOUR BASIC PRINCIPLES OF BIOMEDICAL ETHICSA CHECKLIST FOR ETHICAL DECISION MAKINGRESPECT FOR AUTONOMYDoes my action impinge on an individual's personal autonomy?Do all relevant parties consent to my action?Do I acknowledge and respect that others may choose differently?BENEFICENCEWho benefits from my action and in what way?NON-MALEFICENCEWhich parties may be harmed by my action?What steps can I take to minimise this harm?Have I communicated risks involved in a truthful and open manner?In the event of a disaster, how can I avert the possible harm caused?JUSTICEHave I identified all vulnerable groups that may be affected by my action?Is my proposed action equitable? How can I make it more equitable?Source: Beauchamp, T. & Childress, J. (2001) Principles of Biomedical Ethics, 5th Ed, Oxford University Press, Oxford.A sound ethical decision-making process may incorporate the following abilities;1. The ability to identify all related issues pertaining to the incident/issue/dilemma.2. The ability to sort morally relevant issues from morally irrelevant issues in any given situation.3. The ability to unpack the elements of morally relevant information.4. The ablity and willingness to research issues and reflect upon them.5. The ability and willingness to seek advice.6. The ability to form a well-reasoned, unbiased, and morally defensible conclusion in any given situation.7. The ability to justify this position and act upon it.8. The ability to challenge one's own moral framework in light of recalcitrant experiences.9. Being in possession of a consistent moral framework.MAJOR ETHICAL THEORIESAction-based Approaches to EthicsPrinciplism is a widely applied ethical approach based on fourfundamental moral principles sometimes referred to as ‘the big four’.Developed in the 1970s by the Americans Tom Beauchamp and JamesChildress, the principlist approach applies the principle of respect forautonomy, the principle of beneficence, the principle of non-maleficenceand the principle of justice to contemporary ethical dilemmas. Although thisapproach is sometimes criticised for its lack of foundational theory and itsWestern-dominated methodology, principlism is widely used as a startingpoint for practical ethical decision-making in the clinical, technological andepidemiological professions.Further Reading: Beauchamp, T. and Childress, J. (2001) Principles of Biomedical Ethics, 5thEdition, Oxford University Press, Oxford.Consequentialism refers to a group of normative ethical theories whichmaintain that the moral status of an action is determined by the goodnessor badness of its consequences. One common type of consequentialism isutilitarianism where a decision is made regarding the best course of actionby simply applying a cost-benefit analysis to the situation. A commonlyaccepted utilitarian calculus for determining an action’s moral acceptabilityis; “the greatest happiness for the greatest number.” Thus, aconsequentialist would typically attempt to calculate the consequences oroutcome of a decision and if the benefits of the outcome are outweighedby the risks of either not performing the action or performing some otheraction, then the action is considered as morally desirable.Critics of consequentialism often cite situations in which the application ofa consequentialist theory runs into trouble. For instance, consequentialismwould allow actions of slavery or torture if the benefits to the majorityoutweighed the harms to those who were enslaved to tortured. Morespecific versions of consequentialism have attempted to address thisproblem with some success.Further Reading: Singer, P. (1979) Practical Ethics, Cambridge University Press, Cambridge.The term non-consequentialism is given to a group of ethical theoriesthat do not determine the moral status of an action solely by the goodnessor badness of its consequences. Rather than calculating theconsequences of an action and then deciding whether the benefits ofperforming that action are outweighed by its risks, a non-consequentialistwill tend to take other considerations into account when deciding upon themorally right course of action.The most referred to non-consequentialist ethical theory is deontology. Adeontologist simply judges the moral acceptability of an action using arights-based or duty-based system of analysis. In other words, a personwho adopts a deontological system of ethical decision-making will typicallythink in terms of ‘a person’s right to act in some way’ or ‘a right to possesssomething.’ Decisions are also made using duty-based justifications suchas ‘a duty to act on a certain principle’ or a ‘duty not to hinder some courseof action.’Deontologists are sometimes confronted with the problem of conflictingduties or rights. Thus, a morally right course of action may reveal thatthere are in fact two opposing rights applicable in any one situation.Further Reading: McDonald, H. P. (2001) Toward a Deontological Environmental Ethic,Environmental Ethics, 23 (4), 411-430.Agent-based Approaches to EthicsVirtue-based approaches to ethics place importance on the character ofthe person performing the action rather than on the action itself. Virtueethics has its roots in Greek philosophy in the work of Aristotle and mostrecently in the work of Phillipa Foot and Alasdair MacIntrye. Hierarchies ofvirtues, like vices, have changed over time but generally include justice,temperance, charity, mercy and wisdom to name a few. Generally, virtueethicists believe that traditional moral theories fail to acknowledge theimportance of the role of inner character traits in ethical decision-making.Situation-based Approaches to EthicsCasuistry is the name given to a newly revived school of ethical thoughtoriginating in 16th Century Spain. Casuists argue that specific casesinform moral principles, not vice versa. Thus, the best starting point forethical-decision-making is examining particular cases and the respectivedecisions made about those cases. Casuistry is most easily applied todilemmas in medical ethics where case study provides for effectiveteaching practices.Further Reading: Jonsen, A. R. and Toulmin, S. E. (1988) The Abuse of Casuistry: A History ofMoral Reasoning, University of California Press, Berkley.Relativism is the view that moral appraisals are essentially dependentupon a moral code that is specific to a time, place and culture. There areno absolute criteria with which moral actions may be appraised. A relativistmay cite geographical, historical or anthropological data in support of his orher case. In short, moral relativism accepts what all human beings do asappropriate in their contexts. There is no basis for ethical argument ordiscussion.Modern feminist approaches to ethical analysis developed in theseventies as a response to criticisms that contemporary fundamental moralprinciples generally failed to consider the importance of moralrelationships, the role of emotion and the subjective in moral reasoningand generally failed to redress the repression of women in decisionsconcerning themselves. This alternative turns attention from moraljudgements to focus on the importance of the moral impulse or moralattitude. Sometimes called an ethic of care, this approach to ethicsconcentrates on the “being” of ethics rather than on the “doing”, much likea virtue ethics position. The central focus of an ethic of care is on loving,caring, empathy and sensitivity.Further Reading: Tong, R. (1997) Feminist Approaches to Bioethics: Theoretical Reflections andPractical Applications, Westview Press, Boulder, Colorado.Geocultural approaches to ethics vary considerably from region to region.Generally, they are responses to traditional Westernized approaches toethical decision-making which are criticised as appealing to mostlyAmerican cultural traditions. South America, Asia and Northern Europe areregions where more culturally-specific approaches to ethics have beendeveloped where, perspectives on liberty, social justice and the value of lifediffer significantly.Further Reading: Wulff, H. (1994) Against the four principles: a Nordic view, In Principles ofHealth Care Ethics, R. Gillon and A. Lloyd (Eds.), Wiley, New York.Prepared by Lucy CarterOffice of Public Policy and EthicsInstitute for Molecular BioscienceThe University of Queensland, Australiahttp://www.uq.edu.au/oppeOctober 2002